Provider Demographics
NPI:1174713697
Name:LAKESIDE PREPARATORY ACADEMY
Entity type:Organization
Organization Name:LAKESIDE PREPARATORY ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL LEADER
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAELICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-861-5902
Mailing Address - Street 1:2401 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-2322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-2322
Practice Address - Country:US
Practice Address - Phone:216-861-5902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)